Healthcare Provider Details

I. General information

NPI: 1801980388
Provider Name (Legal Business Name): DOUGLAS S. HONG DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12213 PECOS ST STE 100
WESTMINSTER CO
80234-3414
US

IV. Provider business mailing address

12213 PECOS ST SUITE #100
WESTMINSTER CO
80234
US

V. Phone/Fax

Practice location:
  • Phone: 303-255-0500
  • Fax: 303-255-0900
Mailing address:
  • Phone: 303-255-0500
  • Fax: 303-255-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9253
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: